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Reconstruction of the oropharynx and the hypopharynx is difficult due to their wide diameters. We report eight cases of circumferential pharyngolaryngectomies for epidermoid carcinomas of the hypopharynx extended to the oropharynx and classified T4. Reconstruction was performed with a U-shaped free jejunal transplantation. This specific technique consists of a side to side anastomosis between two loops of jejunum. It facilitates reconstruction at the level of the oropharynx and diminishes postoperative complications.

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.

Reconstruction of the oro and hypopharynx has specific difficulties due to their wide diameters. Seven patients underwent reconstruction with a free U-shaped jejunal transplant, after circular pharyngolaryngectomy for hypopharyngeal cancer invading the oropharynx. This transplant included a side-to-side anastomosis between the two limbs of the jejunal loop. This transplant allowed reconstruction of the upper digestive tract after wide carcinologic resection of the pharynx. The U-shaped jejunal transplant facilitated the upper anastomosis, especially at the upper part where the resection involved the oropharynx. It formed a reservoir behind the tongue, and avoided nasal reflux. The best indications are large resections involving the oropharynx.

A series of 23 patients with sphenoid disease were seen between 1992 and 1997. The most common symptom was headache. This headache was found to be nonspecific. Cranial nerve abnormalities were found in two patients. The different types of radiolographic images were analyzed, and compared with the surgical diagnosis. Twenty-one patients underwent surgical exploration by intranasal endoscopic sphenoidotomy. This approach allowed drainage and inspection of the sinus.

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

Among a series of 520 parotidectomies performed between 1975 and 1995, we observed 88 cases of malignancy (17%). For this study, we excluded skin cancers which had invaded the parotid and glandular metastases of squamous cell carcinoma, malignant melanoma or kidney cancers, retaining only tumors with a glandular origin and lymphomas. Thus defined, our series comprised 60 patients, i.e. 12% of the operated parodids (31 confirmed cancers, 18 tumors with intermediary malignancy, including several in which the pathology report confirmed malignancy, and 11 lymphomas). We examined therapeutic management by histology and compared the outcomes. Relation with the facial nerve are discussed. Prognosis depends on histology, tumor stage and treatment.

One hundred and ninety seven patients with cancer of the hypopharynx underwent after circular resection, reconstruction with a free jejunal graft. The quality of free jejunal grafts is controlled by many investigations: clinical examination, radiography, electromyography, fibroscopy with biopsy. These investigations show that technically jejunal grafts must be short and linear to give the best functional results. Average resumption of oral intake was 14 days. Oral feeding was possible in 92% of cases. The free jejunal grafts with microsurgery are one of the more reliable procedures for reconstruction of pharynx and cervical esophagus after resection for cancer. (2 post-operative deaths and 8 grafts necrosis on 197 cases). The cumulative survival rate of 5 years was 35% for free jejunal graft. Survival depends on selection of the patients for local and nodes invasion. The quality of survival has improved. This operation must be reserved for the hypopharyngeal cancers which need a circular resection and do not invade the esophagus. The surgery is performed for a curative aim. The distant follow up of the patients is imperative: consultation every four months and then every six months: clinical examination, endoscopic, E.N.T., bronchial, and esophageal investigation. Chemotherapy and radiotherapy have specific indications.

Partial or functional surgery for cancers of the upper aerodigestive tract essentially concerns the larynx and the pharyngolaryngeal area. The aim of this surgery is to preserve voice and deglutition. Therefore fundamental anatomical structures such as the cricoid cartilage or at least one arytenoid cartilage must be spared, pointing the limitations of the techniques. Based on these principles, many authors have divided partial surgical procedures ranging from the simplest (cordectomy) to reconstruction on near-total laryngectomy. Cancers of the hypopharynx can benefit from similar techniques always founded on reconstruction by muscle and aponeurosis or by a free flap. Carcinologic results after partial surgery for cancer of upper aerodigestive tract are better than those obtained after total laryngectomy. This fact could be explained by the nature of these cancers that are limited. The carcinologic and functional success of this surgery needs a precise clinical indication and a perfect approach of the various surgical techniques.

Implantable systems for venous access are widely used in cervicofacial cancer. We prospectively evaluated complications related to this type of venous access in our cancer patients.From September 1991 to September 1993, an implantable system for venous access was installed in 164 patients with epidermoid carcinoma of the upper respiratory and digestive tracts. The systems were implanted in the subclavian vein by 20 different operators (mean number of implants per operator = 8.2). All catheters were tunnelized. Chemotherapy was a combination of 5 fluorouracil and cisplatinum.Immediate complications included impossible implantation (n = 12, 7.3%), pneumothorax (n = 5), false passage (n = 4), haematoma (n = 3), arterial puncture (n = 2) and abscess of the thoracic wall (n = 1). During use, complications included extravasation (n = 4), catheter thrombosis (n = 2), venous thrombosis (n = 2) and infection at the site of implantation, desinsertion of the catheter from the chamber, haematoma at the site of implantation and septicaemia (n = 1 each). The rate of complications was related to implantation (17% of the implantations) or to use (8%).The rate of complications due to implantable venous access systems is relatively low, suggesting that these systems are acceptable for ambulatory chemotherapy.

As noticed in our experience, cosmetic results, after total parotidectomy, were better if the patient presented an hematoma. The author got the idea to fill the retro-mandibular defect with a clot. The technique is presented in detail. Fifty four patients had a total parotidectomy between January 1992 and May 1993. A clot was used in 39 of these 54 cases. Were excluded malignant tumors, superficial parotidectomies or the presence of a general pathology (diabetes, cirrhosis). The result was excellent in 31 cases even if a local treatment was necessary due to a secondary hematoma. There was no infectious complication. The follow-up of this series is insufficient, but by analogy with spontaneous hematoma, the results should be persistent. This technique is simple, does not increased the time of the surgical procedure and does not induced injury on any donor site.

We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient who has undergone tympanoplasty 3 months before. Mycological finding led us to consider this fungus as the causative agent. Whereas in vitro studies show a better efficiency of azole derivatives, cure was obtained with nystatine after two treatment failures in our patient.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

This study compared the results of the CT scan of the paranasal sinuses in nasal polyposis patients before and after a topical vasoconstrictor application on the nasal mucosa. No change have been observed either on the maxillary and ethmoidal sinuses, or the middle meatus. On the other hand, an important retraction was observed on the nasal mucosa, in particular on the inferior turbinate. Then, the application of a topical vasoconstrictor on the nasal mucosa does not seem necessary in order to explore the sinuses in patients with nasal polyposis.

Distortion-product otoacoustic emissions are otoacoustic emissions evoked by two pure tones called primaries and proposed in order to provide a frequency specific investigation of the cochlea. This paper first reports complete input-output functions of distortion-product otoacoustic emissions for conventional audiometric frequencies in a population of 35 neonates without any risk for cochlear function. Distortion-product otoacoustic emissions could be useful, in association with evoked otoacoustic emissions and comportemental audiometry, to precisely evaluate the peripheral auditory system in infants and neonates.

Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)

Cancers of the posterior wall of the oro or hypopharynx are rare and do not invade the larynx or the oesophageal orifice. Previously, these cancers were treated with radiotherapy alone, but since 1981 new techniques in reconstruction surgery have allowed a surgical approach. Cancerological non-mutilating exeresis is possible, but reconstruction is difficult since the flap must be very thin to allow normal food intake. In addition, flap reliability is extremely important due to the gravity of cervical salivary fistulation. We treated 15 patients with a lesion of the posterior wall of the pharynx using posterior pharyngectomy and reconstruction with a free antebrachial transplant which was revascularized and reinnervated. In two cases, the operation was performed in patients who had had previous radiotherapy. A branch of the external carotid and the internal jugular vein were used for vascular microanastomoses and reinnervation was obtained using the superficial cervical plexus. The transplant was placed over the prevertebral aponevrosis and sutured to the remaining pharyngeal mucosa. One postoperative death due to heart disease occurred at D + 11. All reconstructions were successful and two salivary fistulas on irradiated tissue closed spontaneously. Postoperative radiotherapy was performed in 11 cases (50-65 Gy) and was well tolerated. These results demonstrate that a highly flexible and thin free forearm transplant is perfectly adapted to reconstruction after posterior pharyngectomy. It is more reliable than local pediculated flaps.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends of the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial histological diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Hearing impairment should be detected in early childhood. Among available screening techniques, acoustic oto-emission testing is a rapid, reliable, noninvasive method which specifically investigates peripheral hearing but does not provide data on auditory nerve centers. This functional test should be carried out within a few days of birth in infants with risk factors for hearing impairment.

Twelve patients with nasal polyposis were examined with magnetic resonance imaging (MRI) prior to surgical ethmoidectomies (20 ethmoidectomies). MRI signal was analyzed in correlation with surgical findings in order to define the semiology of nasal and sinuses polyps. One of the most important point of this semiology is based on the analysis of sequences after administration of gadolinium. MRI seems an interesting method for analysing the extension of nasal polyposis and could be useful for ENT surgeons before an endoscopic nasal surgery.

The internal architecture of the parotid gland was studied by nuclear magnetic resonance (NMR) imaging, particular attention being paid to the intra-parotid portion of the facial nerve. Currently available apparatuses provide high resolution images of previously poorly elucidated anatomic details. Certain authors consider that images in the axial plane in T1 allow direct visualization of the facial nerve and its branches in the form of low frequency linear signals within the gland. The present study, based on radio-anatomic correlations and date determined in a healthy volunteer, demonstrated that these structures correspond in fact to segments of the excretory canal tree, the facial nerve and its branches being invisible on NMR imaging. It is not possible, therefore, to determine the location of a parotid tumor in relation to these nerve elements using this imaging technique.

The aim of this study was to define the most interesting parameters useful for a clinical application of acoustic distortion products (mainly, F1 and F2 primaries frequencies and levels). The most interesting F1 and F2 primaries level in order to separate subjects with a normally-hearing function and patients with a sensorineural hearing loss is 50 dBHL. This result can be explained by some physiological properties of cochlear mechanisms.

This paper presents the first case of human genetic hearing loss due to predominant inner hair cell damage investigated by psychoacoustic audiometry, auditory brainstem responses (ABR), evoked acoustic emissions (EAEs), and distortion product otoacoustic emissions (DPOEs). The genetic transmission was an autosomal dominant inheritance. The audiogram pattern was a dominant high-frequency hearing loss. EAE and DPOE properties were normal. Bronx waltzer mutant mouse with genetically determined predominant inner hair cell defects provide an interesting model to study this congenital deafness. This rare congenital deafness with predominant damage to inner hair cells cannot be detected by neonatal screening techniques using EAEs or DPOEs.

Amplitudes and detection thresholds of evoked otacoustic emissions (EOE) were measured in various groups of subjects: 44 normal young adults, 80 patients with presbycusis and 38 patients with acoustic trauma. Relations between these EOE parameters and tonal audiogram were analyzed. Surprisingly, EOE detection threshold at 1 kHz was strongly correlated with auditory threshold at 2 kHz and no other one. This result demonstrates that some EOE parameters are not frequency-specific. A simple model is implemented in which it is assumed that EOE amplitudes are proportional to the global cochlear activity. This model fits very well experimental data and allows a quantitative evaluation of the residual cochlea. The domain of validity of EOE test in clinics has therefore been precised.

Distortion products are otoemissions produced when the cochlea is stimulated by two pure, continuous sounds f1 and f2. The most ample distortion product in Man corresponds to a frequency of 2f1-f2. The aim of our work is to appreciate the possibilities to study the distortion products for the exploration of low frequencies in Man. Three populations of subjects have been studied: young subjects have been studied: young subjects with a normal hearing, subjects with pathological otoscopic findings in spite of a normal hearing, subjects with pathological otoscopic findings in spite of a normal audiometric study, and subjects with endocochlear perceptive deafness. The major result of this study was to demonstrate that the lowest frequency that can be explored with distortion products is 750 Hertz.

The authors present their experience concerning combined transfacial and neurosurgical procedures in the treatment of carcinomas of the ethmoid sinuses. 109 ethmoid-spheno-orbital tumors were treated at our department from 1982 to 1990: 85 were located into the ethmoidal and/or sphenoidal sinuses; 78 of these were malignant. Among the 65 ethmoidal carcinomas which were operated through a combined route, 48 underwent an induction chemotherapy and 19 a post-operative radiotherapy. The surgical technique is detailed, mostly the intra-cranial approach and the reconstruction of the cranial basis. Clinical results, and particularly the actuarial survival rates are discussed. The 5-year actuarial survival rate is 40% for all first hand ethmoidal adenocarcinomas. The figure reaches 52% for the patients without intra-cranial extension. At last, the 5-year actuarial survival rate is 100% for patients having a complete clinical response to induction chemotherapy.

The free neurovascular antebrachial transplant was described by Yang-Guofan in 1978. In 1981, we brought the description of this free transplant to Europe. Forty-three antebrachial grafts were made to reconstruct the cervicocephalic extremity. We had various indications: floor of the mouth and base of the tongue: 18 cases, facial structures: 7 cases, posterior wall of the pharynx: 9 cases, rescue surgery for esophagoplasty: 6 cases, mandible: 2 cases (using a bone rod taken from the radius), internal aspect of the cheek: 1 case. All grafts were revascularized. In 41 cases, the indications were carcinological, the last 2 cases being benign lesions. The early postoperative mortality included 1 case, not related to the nature of the operation (neoplasm). There was no failure of free transplants. Surveillance was ensured every half-hour during 12 hours, then every 3 hours. Discriminating sensation was recovered in 39 of 43 cases. Mandibular bone reconstructions were knit at the 3rd month. The main disadvantage of removing this graft is esthetic, as it leaves a considerable scar on the forearm. The free antebrachial transplant provides an effective solution to the reconstructions of the cervicocephalic extremity, when a narrow, thin, supple, reinnervated, compound transplant is needed.

Four hundred and thirty-two patients with a carcinoma of the true vocal cord, treated with a partial laryngectomy from 1972 through 1984, were retrospectively analyzed. All patients were staged as NO, MO. Survival and death rates were not presented. A three-year minimum follow-up was achieved in 97% of the cases. Local and cervical recurrences were presented and analyzed. Factors such as local tumor extent, impaired mobility of the true vocal cord, invasion of conus elasticus or thyroid cartilage, and positive margins of resection enhance the outcome of local and cervical recurrences. This present report underscores that thyrotomies, hemilaryngectomies, and cricohyoidoepiglottopexies should be adapted to the exact tumor location and the laryngeal mobilities. Cervical lymph node recurrence is less likely to happen if local control is achieved. The role and rationale for an associated elective ipsilateral cervical and paratracheal lymph chain dissection are presented and advocated.

Between 1980 and 1987, 63 lung cancers associated with upper aero-digestive tract carcinomas were operated on 50% of the primary malignancies of the upper aero-digestive system were laryngeal. These tumors developed synchronously in 13% and metachronously in 87%. The operative mortality rate was 3%. The five years survival rate was 30%. Our results were found identical to those observed in a single lung cancer series. Coin lesion of the lung should be therefore considered as a second primary cancer. Thus, the best treatment is surgical resection. When the option exist, the lung cancer should be treated before the upper airway cancer to avoid the impact of previous irradiation and/or surgical treatment of the upper airway cancer upon the post-thoracotomy management.

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.

Acoustic distorsion products are sounds emitted by the cochlea, in relation with the outer hair cell properties and the micromechanical properties of the Organ of Corti, in response to an acoustic stimulation by two primairies F1 and F2. Acoustic distorsion product 2F1-F2 have been recorded in two populations: 10 normally-hearing subjects and 10 subjects with pure sensorineural hearing losses. Three points are discussed: (i) the test-retest reliability, (ii) the clinical tolerance and (iii) the clinical applications of this test.

Laryngeal nerves were dissected from 100 fresh subjects in order to compare right and left superior and inferior laryngeal nerves. The origin and the distribution of the vascularization was studied. The structure of these nerves was precised through an histomorphometric approach (distribution number of myelinated fibers per mm2, diameter of myelinated fibers). A cartographic study of the laryngeal nerves confirmed the structure of this innervation. The main conclusion of this study is the importance of the plexis structure of the laryngeal innervation and the variations of the nerve fibers diameter as a function of the length of the fiber.

The authors first report the histopathological distribution of 111 parotidectomies carried out between 1965 and 1975. They then describe a case of a malignant tumour of the parotid which was shown by histological examination to be a metastasis of a carcinoma of the kidney, this being the first manifestation of the primary tumour. Finally, the authors review the literature concerning metastases of carcinoma of the kidney to the ENT area. They feel that the great rarity of parotid localisations is due to the fact that they may be confused with an acinous carcinoma of the parotid if histochemical stains are not used.

When confronted with complete chemotherapy-induced histological/clinical regression of a tumor, should the initial therapeutical strategy be modified? Such situations occur more and more frequently. Additional treatment must be carried out in all instances. Indeed, a correlation between complete clinical and histological regression was demonstrated in 66% of cases by histological examination of surgical specimens. It is doubtless recommended to avoid mutilating surgery and to continue chemotherapy for another year. However, whenever partial surgery had been programmed initially, the same indications and excision limits should be maintained. Combination chemical and surgical treatments yield better local results. Nonetheless, this is not always the case and the patient's tolerance to chemotherapy and background should influence the final decision. Radiotherapy then constitutes a choice alternative.

The study was conducted after arterial and venous neoprene latex injection to 100 fresh subjects. Three laryngeal arteries are constant: superior, inferior and posterior. The superior laryngeal artery is of variable origin: in 84% of cases it arises from superior thyroid artery. Anastomoses between the three laryngeal pedicles and the muscle territories supplied by the arteries are described. Vascularization of cartilages is according to a precise plan and cricothyroid and cricoarytenoid joints are the site of constant arterial anatomoses. Origin of superior laryngeal artery fluctuates due to sliding phenomena. The notion of a neurovascular pedicle is fundamental: it is formed by the neural crest derivation and the corresponding artery, that is to say the artery and nerve of a branchial arch. This is to be compared with the notion of pure musculocutaneous and glandular pedicles. The larynx is a junctional zone between 4th and 6th branchial arches and is integrated with the cervicocephalic system of aortic arches.

The authors assessed ganglionic failure in a series of 432 cases of N0 M0 epidermoid carcinomas of the glottic floor following partial laryngeal surgery. The overall of ganglionic failure was 7.8%. This rate of failure is related to 64.7% death rate, i.e. 5.1% of the 432 patients under study. This retrospective study differentiates between primary ganglionic failure and secondary ganglionic failure. Primary ganglionic failure is the first local/regional carcinologic event to develop after treatment of any glottic lesion. Secondary ganglionic failure is related to isolated local failures. The percentage of primary ganglionic failure was 5.1%. It was responsible for deaths occurring in 54.5% of cases. The percentage of secondary ganglionic failure was 2.7% and it was responsible for deaths occurring in 83.3% of cases. Factors promoting ganglionic failure (real tumor extension, tumor infiltration, altered laryngeal mobility, local control and efficacy of retakes of local failures) are discussed. The importance of prophylactic surgical procedures guarding from ganglionic failure, such as the ipsilateral jugular-carotid and recurrent nerve approaches is emphasized. Although such procedures can be of aid in cases of T2 or T3 N0 M0 epitheliomas of the glottic floor, they present no alternative in the course of retake operations of local failures.

In 264 patients operated at Hôpital Boucicault for neoplasma of the parotid gland, 9 presented mucoepidermoid carcinoma and 4 had acinic cell adenocarcinoma. These latter 13 cases of intermediate malignancy tumors were assessed, although the retrospective follow-up period was insufficient to formulate an estimate on the survival rate of these patients. The authors further review the bibliographical data useful in evaluating the prognosis for such neoplasia. They stress the controversy existing around opinions concerning histology-based prognosis and recent advance on nuclear DNA. Indications for postoperative radiotherapy is discussed.

Many procedures are used for reconstruction of a pharyngeal gutter after circular pharyngolaryngectomy, interrupter of digestive continuity. The operation chosen was used of third part of jejunum for reconstruction, and its indications and limitations are described. The choice was based on anatomic data from dissection of 100 cadavers and values for different measurements performed (length of transplant, height of mesentery, caliber and length of vessels), and more particularly on constancy and reliability of vascularization of this digestive segment. To these advantages are added bacteriologic, technical, histologic and physiologic reasons. Results are analyzed of 11 operations carried out in the same department, from among a larger group comprising now 45 cases. Postoperative course was usually uncomplicated with rapid restoration of deglutition (a mean of 11.77 days in 9 of the 11 cases). Preoperative radiotherapy is not a contraindication and postoperative radiotherapy should be given routinely as a complement to surgery. It is usually well tolerated and transplant necrosis is not provoked. Nevertheless, the seriousness of this type of lesion is underlined by the high incidence of carcinologic failures, with an elevated risk of local and regional recurrence and of distant metastases.

Study of 168 cases of ear surgery, from September 1979 to September 1981. Various anaesthetic protocols were compared with a view to decreasing per-operative bleeding: --in 9 cases: Fluothane --in 11 cases: Alfatesine --in 89 cases: Neuroleptanalgesia --in 39 cases: Narcozep. The various proposals for controlled hypotension are discussed and the conclusion is drawn that, regardless of the method used, the percentage of failures was essentially identical and seemed to be related more to errors in assessment of the duration of the operation than to the drug used. A corollary to this attitude was the possibility of a 25% rate in delayed post-anaesthetic recovery.

This is an analysis of 4 patients with suspicion of centro-facial granulomatosis. Diagnosis is difficult, mainly based upon clinical data, without precise histopathological presentation. The main differential diagnosis is Wegener's granulomatosis. The etiology of centrofacial granulomatosis is still unknown but multiple theories have been proposed: systemic disease, lymphoma. In one case, the initial histopathological diagnosis was undifferentiated carcinoma and the patient received chemotherapy (i.e., Adriamycin, Vincristine, Bleomycin and Steroids). A complete response was achieved. The interest of chemotherapy in the treatment of centro-facial granulomatosis is discussed.

The authors report a series of 63 cases, all operated, of bronchial cancer associated with upper airway cancer. The laryngeal portion of the upper airways was the site of cancer in 50% of cases. The two cancers occurred synchronously in 13% and at different times in 87% of cases. Operative mortality was 3%. Post-operative complications were dominated by bronchopulmonary congestion. Long-term survival was similar to that in series of operated bronchial cancer alone and was 70% at one year and 30% at five years. These results should lead to all isolated pulmonary lesions being considered as second primary cancers with early surgical resection being proposed.

Before they give their results, the authors, whose experience of sclerosis of oesophageal varices under the oesophagoscope has so far involved 157 patients, deal specifically with the problems facing the anaesthetist and resuscitator when this technique is used, tolerance of the product injected and possible accidents. Firstly, they point out the unsuitability of the patients referred to them by their medical or surgical colleagues. By implication therefore, treatment should only be undertaken with the assistance of a team of experienced resuscitators and every precaution taken to mitigate the effects of possible accidents to these patients who are particularly at risk. These cases are mainly characterized by serious haemorrhages (seven cases described, one resulting in death). Oesophageal injury is, on the other hand, the exception where trained personnel are involved (2 minor mucosal tears out of more than 800 oesophagoscopies). Finally, secondary parietal oesophageal necrosis occurs. Quininaemia assessment after injection of quinine-urea confirms that the product is being efficiently eliminated. Overall results reveal a survival rate of 61 p. 100 after more than a year and 20 p. 100 after more than than three years. These figures underline the limitations of therapeutic possibilities and the serious prognosis for this result of portal hypertension. This leads the authors to express a wish that the procedure should be used as a measure to prevent haemorrhage as soon as the presence of varices is realized. On the other hand, they reject on practical grounds emergency sclerosis of oesophageal varices, as a direct heamostatic method, since, according to their statistics, this almost invariably results in failure.

Invasion of the hyothyroepiglottic (HTE) space, or pre-epiglottic space, constitutes an important element in selecting the type of therapy in cancer of the larynx (functional surgery, radiotherapy), the oropharynx and the hypopharynx. Clinical examination and standard X-ray films provide insufficient information. High frequency real time ultrasonography offers a reliable means for exploring the pre-epiglottic space, as evidenced by this study carried on 34 histologically-confirmed cases taken among 77 cases of carcinoma of the upper digestive and respiratory tracts. Advantages presented by this method over CT-scanning and MR imaging in this particular pathological are simplicity, rapidity and low cost, combined with good performance.

Of a total of 219 partial laryngectomies performed, 119 were cordectomies, 30 hemilaryngectomies and 70 supraglottic laryngectomies. Results of each type of operation are presented with emphasis on problems of local recurrences, evidence of validity of procedure selected and of its indications. Analysis of results, with the reservation that indications were sometimes wide but always reasonable, showed an extremely low incidence of recurrences, the quality of the resection (limited or insufficient) having finally little incidence on the latter, except perhaps in the supraglottic laryngectomies. It is suggested, therefore, that no attempt should be made to "recover" a histologically detected insufficient excision by complementary radiotherapy not required in principle. This assists follow up review and allows secondary therapy if an unfavorable course is noted.